Lipoatrophy - can fat be restored?

Oct 17, 2009

I was previously taking combivir for about 7 years along with another drug- Viread and noticed about two years ago, my face was starting to look somewhat drawn. Mostly in the temple area. The doctor recently said how he is noticing the temple area is severe with lipo and I need to come off the combivir. I changed to three other meds(truvada and isentress), but I have conflicting information. I signed up for sculptra through an access program, but the doctor I see said fat never restores to the body once it has been destroyed. Other doctors I've seen on the web, say that fat restoration is possible. I'm annoyed that this doctor "just now" told me how my look was a bit severe and needed to change my meds. Another odd thing is that the fat loss is only in the temple area and my cheeks are completely normal. Is it true or false that fat cannot be restored once it has been elminated by the AZT in combivir?

Response from Dr. Pierone

I don't think that we fully know the answer to your question.

In the SWEET study switching AZT to Viread did lead to improved body fat when in patients who had been on AZT for less than 3 years, but not in patients who had been on AZT for longer periods. But these differences were measured one year after the switch, so perhaps the patients on long-term AZT might need a longer period of time to rebuild fat stores. We really don't know.

We know from other studies that fat cells are injured by AZT and d4T and presumably some become so damaged that they die. Whether these dead fat cells are replaced by new ones is not known. However, my observation has been that some patients with well established lipoatrophy may not notice improvement even if they go off antiretroviral therapy altogether or switch to nuke-sparing regimens. This would imply that the capacity for fat cell replenishment is limited, at least for some individuals.

With regard to the face, Sculptra and other fillers don't replace fat cells, but can certainly increase facial fullness and produce results that are indistinguishable from facial fat restoration.

Finally, fat grafting is currently an imperfect science and results are decidedly mixed. Some people get wonderful results, others the opposite. But given the pace of medical progress, it is not unrealistic to think that one day we will be able to harvest some fat cells from an individual, expand them in a petri dish, and then graft them back to areas that need fat restoration.

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